J Yeungnam Med Sci.  2023 Jan;40(1):91-95. 10.12701/yujm.2021.01543.

Diagnosis and successful visual biofeedback therapy using fiberoptic endoscopic evaluation of swallowing in a young adult patient with psychogenic dysphagia: a case report

• Kim Y
• Han SH
• Shin YB
• Yoon JA
• Kim SH

• KMID: 2538790
• DOI: http://doi.org/10.12701/yujm.2021.01543

Abstract

Psychogenic dysphagia is a deglutition disorder characterized by a fear of swallowing, with no structural or functional causes. This report presents the case of a young male patient who had severe malnutrition due to psychogenic dysphagia and was provided visual biofeedback using fiberoptic endoscopic evaluation of swallowing (FEES). A healthy 25-year-old man presented to our clinic with a complaint of throat discomfort when swallowing that had started 6 months prior. As the symptoms worsened, he became fearful of food spreading to his lungs after swallowing and the development of respiratory difficulties. His food intake gradually decreased, resulting in a weight loss of 20 kg within 2 months. Evaluation of organic and other functional causes of dysphagia was performed, but no abnormalities were detected. The sensation of a lump in his throat, fear of swallowing, and anxiety were transformed into somatic symptoms. The patient was diagnosed with psychogenic dysphagia. After visual biofeedback by a physician who performed FEES, the patient resumed eating normally and increased his food intake. If routine tests do not reveal structural or functional causes of dysphagia, assessment of a psychogenic swallowing disorder should be considered. FEES can help in the diagnosis and management of psychogenic dysphagia.

Keyword

Deglutition disorders; Fiberoptic endoscopic evaluation of swallowing; Psychogenic dysphagia; Somatoform disorders

Figure

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  Fig. 1. Esophagography shows no structural abnormality or dysmotility from (A) the upper and middle thoracic esophagus to (B) the lower thoracic esophagus and esophagogastric junction.

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  Fig. 2. Fiberoptic endoscopic evaluation of swallowing shows (A) no laryngeal penetration or aspiration and (B) no structural abnormality during phonation.

Reference

References

1. Bülow M. Psychogenic dysphagia. In : Shaker R, Belafsky PC, Postma GN, Easterling C, editors. Principles of deglutition. New York: Springer;2013. p. 771–6.

2. Barofsky I, Fontaine KR. Do psychogenic dysphagia patients have an eating disorder? Dysphagia. 1998; 13:24–7.

3. Scemes S, Wielenska RC, Savoia MG, Bernik M. Choking phobia: full remission following behavior therapy. Braz J Psychiatry. 2009; 31:257–60.

4. McNally RJ. Choking phobia: a review of the literature. Compr Psychiatry. 1994; 35:83–9.

5. Finkenbine R, Miele VJ. Globus hystericus: a brief review. Gen Hosp Psychiatry. 2004; 26:78–82.

6. Ciyiltepe M, Türkbay T. Phagophobia: a case report. Turk J Pediatr. 2006; 48:80–4.

7. Shapiro J, Franko DL, Gagne A. Phagophobia: a form of psychogenic dysphagia: a new entity. Ann Otol Rhinol Laryngol. 1997; 106:286–90.

8. Ravich WJ, Wilson RS, Jones B, Donner MW. Psychogenic dysphagia and globus: reevaluation of 23 patients. Dysphagia. 1989; 4:35–8.

9. Malcomson KG. Radiological findings in globus hystericus. Br J Radiol. 1966; 39:583–6.

10. Casado E, Gratacós J, Tolosa C, Martínez JM, Ojanguren I, Ariza A, et al. Antimalarial myopathy: an underdiagnosed complication?: prospective longitudinal study of 119 patients. Ann Rheum Dis. 2006; 65:385–90.

11. Kalajian AH, Callen JP. Myopathy induced by antimalarial agents: the relevance of screening muscle enzyme levels. Arch Dermatol. 2009; 145:597–600.

12. Knuijt S, Kalf JG, de Swart BJ, Drost G, Hendricks HT, Geurts AC, et al. Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases. Disabil Rehabil. 2014; 36:1285–9.

13. Somer H, Dubowitz V, Donner M. Creatine kinase isoenzymes in neuromuscular diseases. J Neurol Sci. 1976; 29:129–36.

14. Hobson-Webb LD, Jones HN, Kishnani PS. Oropharyngeal dysphagia may occur in late-onset Pompe disease, implicating bulbar muscle involvement. Neuromuscul Disord. 2013; 23:319–23.

15. Ito K, Chitose H, Kobayashi A. Upper airway obstruction caused by a floppy epiglottis: report of two cases of amyotrophic lateral sclerosis (ALS). Nihon Jibiinkoka Gakkai Kaiho. 2009; 112:660–4.

16. Thottam PJ, Silva RC, McLevy JD, Simons JP, Mehta DK. Use of fiberoptic endoscopic evaluation of swallowing (FEES) in the management of psychogenic dysphagia in children. Int J Pediatr Otorhinolaryngol. 2015; 79:108–10.